Diabetic retinopathy (DR) is the leading cause of vision loss in working-aged Americans. Because of the increasing prevalence of diabetes mellitus, the absolute number and proportion of people affected by DR is predicted to increase dramatically in the coming years. Fortunately, when detected early through screening, and therapy is appropriately initiated, vision loss from DR is largely preventable, and for this reason, annual dilated eye exams are recommended for most people with diabetes. Historically, adherence to recommended screening has been poor, with 45-65% of eligible patients receiving appropriate screening. Because of these observations, access to high quality screening has been improved with innovative remote detection programs using ocular telehealth that allow for retinal photographs to be taken in the primary care setting. This has been of particular value for rural and socioeconomically disadvantaged populations with poor access to subspecialty care. Unfortunately, several studies have demonstrated that linkage to care for diagnostic examination and effective therapeutic intervention has been quite poor following successful remote detection of DR. Indeed, the success of the screening has unmasked a problem that threatens the public health achievement of improved screening; the very people most likely to benefit from the increased convenience of ocular telehealth may be the least likely to link to ophthalmic care when needed, i.e., people with poor physical access to care and low socioeconomic status. In the present study, we seek to determine whether providing financial incentive will improve rates of linkage to ophthalmic care. Financial incentives have been proven to be highly effective in improving other health behaviors among disadvantaged populations (e.g., substance abstinence, smoking during pregnancy, weight loss, etc). For this study, we will randomize 62 lowincome adults with diabetes mellitus and suspected DR based on ocular telehealth screening to a treatment condition in which participants receive financial incentives contingent upon linkage to care or to a usual-care condition in which they will receive education about DR. The primary outcome will be successful linkage to care with a with a qualified ophthalmic provider. Cost effectiveness of the intervention will also be examined by comparing the costs of the incentive intervention with its effects on increasing linkage to care.